Put This on the End-of-Year To-Do List

Guest post from
Mary R. Grealy
President, Healthcare Leadership Council
Washington, D.C.

maryThere are not high expectations for this lame duck session of Congress. We may see passage of a bill to authorize the Keystone XL pipeline and there will have to be action on a spending bill to keep the government operating as well as funding measures related to the fights against Ebola and the Islamic State. But, when an election sees one party take over control of one or both houses of Congress, the new victors are usually content to put issues on hold until January when they have greater leverage over the outcomes.

Before the waning days of the 113th Congress elapse, however, there is one more critical item that lawmakers should include on their to-do list.

It’s high time to reform the Medicare payment system for physicians and other healthcare professionals.

Seventeen times since 2003, Congress has passed temporary fixes to prevent healthcare providers from having to absorb a significant reduction in their Medicare reimbursements. This patchwork approach isn’t fair to physicians, patients or taxpayers. Physicians should not have to wait year after year to find out if Medicare will provide a fair payment for treating beneficiaries. Patients don’t benefit from a system that doesn’t encourage healthcare professionals to provide better, evidence-based care at sustainable costs. And taxpayers have had to pay substantially more for these short-term patches than they would have if a sensible, permanent payment system had been implemented in the first place.

There’s no reason this indefensible situation should continue. In fact, it shouldn’t even be kicked over to the next Congress.

Legislation has been developed in both the House and Senate that would not only permanently fix the Medicare physician payment formula, but would also establish a structure to encourage coordinated care and reward healthcare providers for elevating the quality and cost-efficiency of patient care. This legislation has support from both Republicans and Democrats.

Further, there is widespread support in the healthcare and patient communities to act now instead of later.

The new Congress will have plenty on its plate next year. Fixing the Medicare payment formula should become a 2014 achievement, not a 2015 challenge.

Posted in Access to Care, Coding and Reimbursement, Congress, Health, Health Reform, Healthcare Costs, Medicare, SGR | Tagged , , , , , , |

Social Media in Neurosurgery: Are You HIPAA Compliant?

Kris.colenGuest post from
Chaim B. Colen, MD (left)
Chair of the Young Physicians Representative Section of the CSNS
Grosse Pointe Woods, MI
Kristopher T. Kimmell (right)
Neurosurgical Resident, University of Rochester Medical Center
Rochester, NY

The business of medicine is increasingly performed electronically. A wide variety of devices provide neurosurgeons with patient information right at their fingertips. Mobile technologies and social media offer tremendous potential to enhance neurosurgical practice and augment patients’ involvement in their care. However, there are two particular issues that neurosurgeons must give heed to when harnessing the power of mobile technologies and social media. The first is potential breaches of patient personal health information (PHI). The second is to maintain professional conduct in the use of social media for advocacy, marketing, and patient outreach.

Violations of the Health Insurance Portability and Accountability Act, or HIPAA, can come with substantial financial penalties. Fines from the Department of Health and Human Services for HIPAA breeches can easily reach six figures, irrespective of any civil liability. Neurosurgeons must be aware that they are responsible for their employees’ use of social media as well. An OB/GYN practice in Pennsylvania nearly ran afoul of HIPAA after an employee posted derogatory comments about patients on Facebook. Neurosurgeons should familiarize themselves with the keys aspects of HIPAA regulations as they relate to the use of electronic devices and social media. Detailed information can be found at the HHS HIPPA website by clicking here.

iphoneSocial media websites represent another avenue for PHI breaches in medicine. Physicians report high rates of use of social media websites (almost 90 percent by one report). Social media is being accessed by physicians not only for personal use but increasingly for professional networking. On platforms like Sermo or Doximity, physicians can engage in real-time case discussion with colleagues on challenging diagnoses or debate therapeutic options. Moreover, online patient communities have become tremendous forces for patient education and advocacy and can represent a great opportunity for providers to reach out to new patients and increase patient awareness and adherence. However, social media does present challenges for providers. The Federation of State Medical Boards (FSMB) recently published Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice for physicians. The FSMB Guidelines point out that physicians may be subject to disciplinary action by their medical board for inappropriate use of social media with the potential for license revocation in cases of flagrant violations. Similar to HIPAA breeches, neurosurgeons are monetarily liable for inappropriate social media use by themselves and their employees.

Most healthcare institutions have well-established policies and guidelines to prevent HIPAA violations. Some medical centers have also developed social media policies. Neurosurgeons should work closely with their own institutions to adopt appropriate practices and procedures. Ultimately neurosurgeons are responsible for their own use of mobile technologies and social media to carry out the practice of neurosurgery. Below are some things to consider in using mobile technologies and social media in your practice:

• Make sure that all devices (smartphones, tablets, laptops, etc) are password protected
• Take every precaution to protect patient’s privacy
• Provide candid disclosure of conflict of interest
• Avoid posting information that could be taken out of context
• Maintain an atmosphere of professionalism at all times

There is no question that social media and mobile technologies have dramatically impacted the way we communicate. And, even though these tools add valuable knowledge to a physician’s toolbox, it’s important for neurosurgeons to be mindful of the responsibility associated with them.

Posted in Guest Post, HCSM, Health, Healthcare Social Media | Tagged , , , , , |

Dartmouth Atlas Finds Significant Variations in Cerebral Aneurysm Care; Cites Importance of Neurosurgery’s Registry in Improving Patient Outcomes

Guest Post by Nicholas Bambakidis, MD
Professor of Neurosurgery and Director, Cerebrovascular and Skull Base Surgery
Residency Program Director, Neurological Surgery
University Hospitals Case Medical Center
Cleveland, OH

bambakidis_photoThe Dartmouth Institute recently published a review of cerebral aneurysm care as part of their “Atlas of Health Care” series. The report, “Variation in the Care of Surgical Conditions: Cerebral Aneurysms A Dartmouth Atlas of Health Care,” focuses on unwarranted variation of surgical care in the United States, which is not explained by patient needs or preferences. The review includes recent literature on outcomes in the treatment of both ruptured and unruptured cerebral aneurysms. The report found that the frequency of endovascular coiling of aneurysms has increased on average in recent years, but after the initial surge, the use of coiling has stabilized to between 60-70 percent of aneurysm treatment. Likewise, after an initial decline in aneurysm clipping, rates have stabilized, and clipping continues to be a mainstay of aneurysm treatment.

The aforementioned findings reflect the realization that emerging endovascular technologies are insufficient to adequately treat all aneurysms and lead to significant rates of recurrence and the need for retreatment in some cases. It also points out the importance of individualizing treatment based on patient-specific criteria. The study found significant variation regionally across the United States with respect to rates of clipping vs. coiling, which, unfortunately, may be related to other factors such as physician training, experience, and preference.

aneurysm image

Image of an aneurysm

In order to minimize such extraneous influences, it is important that high quality specialized care in all aneurysm treatment modalities be available at centers of excellence, such as Comprehensive Stroke Centers (CSC) that are certified by the Joint Commission. Unfortunately, the Cerebrovascular Coalition — which includes national physician specialty societies (including the AANS and CNS) whose members treat stroke patients — is concerned that the current CSC criteria are insufficient to guarantee appropriate expertise in all aneurysm treatment modalities. It is, therefore, imperative that the Joint Commission modify these standards to best meet the needs of patients.

The Dartmouth study also points out that the best outcome with respect to aneurysm treatment (either clipping or coiling) remains controversial and is still an important gap in knowledge. The study proposes further research into outcomes through the use of clinical data registries. Importantly, the authors highlighted the launch of the cerebrovascular module of the National Neurosurgery Quality and Outcomes Database (N2QOD) as an ideal effort in this regard. This reinforces the notion, in the absence of complete registry data, multimodality therapy must be available in order to best offer adequate treatment options to patients with cerebral aneurysms and to avoid unwarranted variation of aneurysm care which is not grounded in sound scientific rationale.

At the end of the day, patients who receive a new diagnosis of cerebral aneurysm (especially unruptured) face a difficult road to informed decision-making. Understanding their needs, addressing their concerns, and creating new quality paradigm, which promotes the use of clinical outcome registries, will be central to the process of minimizing variability and orchestrating a patient-centered approach to cerebral aneurysm treatment.

Posted in Access to Care, Guest Post, Health, Quality Improvement | Tagged , , , , , , , |